Heier T, Hetland S
Department of Anesthesia, Ullevål University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 1999 May;43(5):550-5. doi: 10.1034/j.1399-6576.1999.430511.x.
It is not known if the information on neuromuscular function obtained from the hand is interchangeable with that of the foot. In the present study the agreement of thumb mechanomyography with acceleromyography of the big toe was studied.
Ten healthy patients scheduled for oral surgery were studied. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol 2 mg kg-1, and maintained with propofol 100-175 micrograms kg-1 min-1, nitrous oxide 60-70%, and fentanyl 1-2 micrograms kg-1 h-1. Vecuronium 0.1 mg kg-1 was used for muscle relaxation. Mechanomyography (MMG) of the thumb (Myograph 2000) and acceleromyography (AMG) of the big toe (TOF-Guard) were recorded simultaneously in all patients, and onset, period of no-twitch response, duration of action, and spontaneous recovery time obtained from both muscle groups. The agreement between methods was tested by calculation of bias and limits of agreement.
The onset time and duration of action were significantly shorter (87 s vs 154 s, and 35 min vs 38 min, respectively), and the spontaneous recovery time significantly longer in the thumb than in the big toe (32 min vs 19 min). Period of no-twitch response was not significantly different in the two muscle groups. Limits of agreement (thumb big toe) were -21 to -113 s, -7 to 1 min, and -9 to 35 min, for onset time, duration of action, and spontaneous recovery time, respectively.
We conclude that clinically acceptable agreement between thumb mechanomyography and big toe acceleromyography was found for the period of no-twitch response, suggesting that the timing of supplemental doses of vecuronium can be guided by AMG at the big toe. However, the spontaneous recovery time agreement (to TOF ratio = 0.75) between the thumb and the big toe was poor.
从手部获得的神经肌肉功能信息是否与足部的信息可互换尚不清楚。在本研究中，对拇指机械肌电图与拇趾加速度肌电图的一致性进行了研究。
对10例计划进行口腔手术的健康患者进行研究。用2微克/千克的芬太尼和2毫克/千克的丙泊酚诱导麻醉，并用100 - 175微克/千克·分钟的丙泊酚、60 - 70%的氧化亚氮和1 - 2微克/千克·小时的芬太尼维持麻醉。使用0.1毫克/千克的维库溴铵进行肌肉松弛。在所有患者中同时记录拇指的机械肌电图（Myograph 2000）和拇趾的加速度肌电图（TOF - Guard），并从两组肌肉中获得起效时间、无抽搐反应期、作用持续时间和自主恢复时间。通过计算偏差和一致性界限来测试两种方法之间的一致性。
拇指的起效时间和作用持续时间明显更短（分别为87秒对154秒和35分钟对38分钟），拇指的自主恢复时间明显长于拇趾（32分钟对19分钟）。两组肌肉的无抽搐反应期无显著差异。起效时间、作用持续时间和自主恢复时间的一致性界限（拇指对拇趾）分别为 - 21至 - 113秒、 - 7至1分钟和 - 9至35分钟。
我们得出结论，在无抽搐反应期，拇指机械肌电图与拇趾加速度肌电图之间发现了临床可接受的一致性，这表明维库溴铵补充剂量的时机可以由拇趾的加速度肌电图来指导。然而，拇指与拇趾之间的自主恢复时间一致性（至四个成串刺激比值 = 0.75）较差。
